Attitudes of nursing and rest home administrators toward deinstitutionalized elders with psychiatric disorders

Abstract

The administrators of 92 nursing homes and rest homes in western Massachusetts were surveyed on their experiences with elderly residents with a history of psychiatric hospitalization and their willingness to admit such individuals in the future. A majority of those who had admitted deinstitutionalized elders with chronic psychiatric disorders reported having experienced severe problems with them. Most of the problems involved the resident going into crisis or producing some highly disruptive behavior. Although two-thirds of the facilities had admitted elders who had been deinstitutionalized from a public psychiatric hospital, only one-quarter clearly planned to do so in the future. Three quarters of the administrators reported that they did not have the support services that the deinstitutionalized elders in their facilities needed. A comparison of the services reported to be important and those reported to be available suggest that simply increasing the availability of psychiatric support services would probably not influence administrators to admit elders with chronic mental illness in the future.

Are Patients With Serious Mental Illness More Likely to be Admitted to Nursing Homes With More Deficiencies in Care?

“…First, given the current level of demand for nursing home care, many facilities still enjoy substantial flexibility in admitting different types of patients. Nursing home administrators may selectively avoid accepting patients with SMI 34 because they are worried about their socially inappropriate and many times dangerous behaviors, 2 and about the fact that their staff may not be competent enough to serve appropriately these patients. As a result, patients with SMI may be crowded out of the locally reputable nursing homes (ie, in terms of service quality) that are attractive to all prospective entrants; and they may be clustered into nursing homes that tend to house less desirable patients or locate in poor urban areas, have lower occupancy rates, provide less adequate services, and therefore be more inclined to accept these challenging patients.…”

Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care

“…The Deinstitutionalization of the Long‐Term Psychiatric Population . Lower‐tier facilities, particularly for‐profit facilities, are much more likely to serve the least desirable long‐term care residents, those with a history of psychiatric diagnoses (Mosher‐Ashley and O'Neill 1991). Many of these facilities may be serving the legacy of national policy directed at the deinstitutionalization of public mental hospitals over the last several decades (Mishara, Budd, and Dixon 1973).…”

Disruptive Behaviors in Veterans Affairs Nursing Home Residents: How Different Are Residents with Serious Mental Illness?

“…Nursing home administrators have cited concerns about potential behavior problems as a major factor affecting decisions about whether to admit individuals with serious mental illness (SMI), 6 but these administrators have also reported that residents with SMI are basically similar in general behavior to the general residential population. Facility administrators' inconsistent reports regarding the behaviors of residents with SMI raise the possibility that stigma and anxieties associated with SMI may affect admission and care decisions.…”